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General NPI Number Information
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NPI Number | 1073822607
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Entity Type | Individual
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Provider Name | EDWARD HARDIN SMITH JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/30/2010
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Last Update Date | 09/30/2010
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Provider Practice Location Address
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Address Line | 514 WINCHESTER DR
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City | AUGUSTA
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State | GA
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Zip | 30909-3236
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Country | US
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Telephone | 706-738-2292
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Fax | 706-738-2292
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Provider Business Mailing Address
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Address Line | 514 WINCHESTER DR
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City | AUGUSTA
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State | GA
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Zip | 30909-3236
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Country | US
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Telephone | 706-738-2292
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Fax | 706-738-2292
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 011565
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License Number State | GA
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